Skip to main content

Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism



Conventional treatment of chronic hypoparathyroidism consists of oral calcium supplements and active vitamin D analogs; however, some patients are unable to meet treatment goals despite the high dosage of oral calcium supplementation. We aimed to investigate the effectiveness of alternate-day oral calcium intake in patients with uncontrolled chronic hypoparathyroidism.


In this retrospective cohort study, we evaluated 66 patients with chronic hypoparathyroidism who were admitted to our hospital between January 2017 and January 2019. Fourteen patients receiving ≥ 2000 mg/day oral elemental calcium and who were admitted to emergency department or our outpatient clinic at least once in the last 3 months for hypocalcemia requiring intravenous calcium replacement were switched to the alternate-day dosing regimen in which patients took calcium orally every other day. We collected and analyzed patients’ medical history information, serum and urinary parameters over a 3-month period prior to and following the treatment.


Before alternate-day dosing regimen, median oral calcium intake was 3750 mg/day, oral calcitriol intake was 0.88 mcg/day, serum calcium levels were 7.71 mg/dL, serum phosphate levels were 5.35 mg/dL, and 24-h urine calcium levels were 165 mg/day. Following alternate-day dosing regimen, median oral calcium intake was 1500 mg/day, oral calcitriol intake was 0.88 mcg/day, serum calcium levels were 8.25 mg/dL, serum phosphate levels were 5 mg/dL, and 24-h urine calcium levels were 210.5 mg/day. After alternate-day dosing regimen, oral calcium intake decreased and serum calcium levels increased. The number of emergency visits dropped from 21 to 3 after alternate-day dosing regimen.


Patients with uncontrolled chronic hypoparathyroidism could be controlled more effectively with alternate-day dosing regimen.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Lopes MP, Kliemann BS, Bini IB, Kulchetscki R, Borsani V, Savi L, Borba VZC, Moreira CA (2016) Hypoparathyroidism and pseudohypoparathyroidism: etiology, laboratory features and complications. Arch Endocrinol Metab 60:532–536.

    Article  PubMed  Google Scholar 

  2. 2.

    Bollerslev J, Rejnmark L, Marcocci C, Shoback DM, Sitges-Serra A, Van Biesen W, Dekkers OM (2015) European Society of Endocrinology clinical guideline: treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol 173:G1–G20.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Marcucci G, Brandi ML (2019) Conventional treatment of hypoparathyroidism. Front Horm Res 51:160–164.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Rubin MR, Cusano NE, Bilezikian JP, Brandi ML, Potts JT Jr, Mannstadt M, Rejnmark L, Rizzoli R, Winer KK, Liberman UA (2016) Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab 101:2313–2324.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Winer KK, Yanovski JA, Sarani B, Cutler GB (1998) A randomized, cross-over trial of once-daily versus twice-daily parathyroid hormone 1–34 in treatment of hypoparathyroidism. J Clin Endocrinol Metab 83:3480–3486.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Mannstadt M, Clarke BL, Vokes T, Brandi ML, Ranganath L, Fraser WD, Lakatos P, Bajnok L, Garceau R, Mosekilde L, Lagast H, Shoback D, Bilezikian JP (2013) Efficacy and safety of recombinant human parathyroid hormone (1–84) in hypoparathyroidism (REPLACE): a double-blind, placebo-controlled, randomised, phase 3 study. Lancet Diabetes Endocrinol 1:275–283.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Hoenderop JGJ, Nilius B, Bindels RJM (2005) Calcium absorption across epithelia. Physiol Rev 85:373–422.

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Nilius B, Prenen J, Vennekens R, Hoenderop JGJ, Bindels RJM, Droogmans G (2001) Modulation of the epithelial calcium channel, ECaC, by intracellular Ca2+. Cell Calcium 29:417–428.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Saha S, Goswami R (2019) Auditing the efficacy and safety of alfacalcidol and calcium therapy in idiopathic hypoparathyroidism. J Clin Endocrinol Metab.

    Article  PubMed  Google Scholar 

  10. 10.

    Al-Sharefi A, Glenister E, Morris M, Quinton R (2019) Is calcium supplementation always needed in patients with hypoparathyroidism? Clin Endocrinol (Oxf).

    Article  Google Scholar 

  11. 11.

    Bianco SD, Peng J-B, Takanaga H, Suzuki Y, Crescenzi A, Kos CH, Zhuang L, Freeman MR, Gouveia CH, Wu J, Luo H, Mauro T, Brown EM, Hediger MA (2006) Marked disturbance of calcium homeostasis in mice with targeted disruption of the Trpv6 calcium channel gene. J Bone Miner Res 22:274–285.

    Article  Google Scholar 

  12. 12.

    Benn BS, Ajibade D, Porta A, Dhawan P, Hediger M, Peng J-B, Jiang Y, Oh GT, Jeung E-B, Lieben L, Bouillon R, Carmeliet G, Christakos S (2008) Active intestinal calcium transport in the absence of transient receptor potential vanilloid type 6 and calbindin-D9k. Endocrinology 149:3196–3205.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Peng J-B, Suzuki Y, Gyimesi G, Hediger MA (2018) TRPV5 and TRPV6 calcium-selective channels. In: Kozak JA, Putney JW Jr (eds) Calcium entry channels in non-excitable cells. CRC Press/Taylor & Francis, Boca Raton, pp 241–274

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to T. Akkan.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Kecioren Clinical Research Ethics Committee (2012-KAEK-15/1811).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Akkan, T., Dagdeviren, M., Koca, A.O. et al. Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism. J Endocrinol Invest 43, 853–858 (2020).

Download citation


  • Alternate-day dosing
  • Chronic hypoparathyroidism
  • Calcium
  • Emergency visits